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Male Infertility

What is Male Infertility?

This is when a man produces no, or has a very little sperm count. It can stop couples having babies, and sometimes be caused by another more serious STI or sexually transmitted disease.

Misconceptions are very common in the world of infertility. One popular myth is that infertility is the woman's problem and that once that "problem" is fixed, the couple will be able to conceive. This could not be farther from the truth. In fact, in nearly 30% of all infertility cases, the cause is attributed to a factor in the male and in an additional 30% of cases the cause is attributed to both male and female factors.

Estimates state that as many as 15% of all couples in the UNited States have difficulty conceiving a child. In one-third of the cases of infertility, the problem is male infertility. Roughly, 6% of men between the ages of 15 and 50 suffer from male infertility.

Most cases of male infertility are the result of abnormal sperm count or low sperm quality. Although it takes only one sperm to fertilize an egg, an average ejaculation contians nearly 200 million sperm. The natural barriers in the female reproductive tract prevent all but about 40 sperm from reaching the egg. The number of sperm in an ejaculation and the degree of fertility are strongly correlated.

Decreased sperm production is the cause of about 90% of cases involving low sperm counts. Unfortunately, an about 90% of these cases, the cause of deficient sperm production can't be found. Two conditions are associated with insufficient sperm: oligospermia and azoospermia. The first refers to a low sperm count while the second is an absence of living sperm in the semen.

Sperm count as well as sperm quality has been decreasing over the last few decades. In 1940, the average sperm count was 113 million per milliliter; by 1990, the value had dropped to 66 million. Adding to this problem, the amount of semen fell almost 20%, from 3.4 milliliters to 2.75 milliliters. Taken these findings together, it tells us that per each ejaculation, men are now supplying only about 40% of the number of sperm men supplied in 1940.

The downward trend in sperm count has led to speculation that recent environmental, dietary, or lifestyle changes are interfering with a man's ability to manufacture sperm. Although the speculation is controversial, substantial evidence supports it.

How do I find out if I am Infertile?

The first thing to do is to go to the doctor, typically a urologist. After a physical examination, your doctor will probably order a semen analysis, which will check the quality and quantity of the sperm in the semen. And yes, your doctor will want you to give the sample there, or at least someplace nearby, since it's important that the analysis take place quickly. Just remember, as sheepish as you might feel, a semen analysis is a commonplace test, and the results could save you months of worry and stress.

If the first semen analysis is normal, your doctor may order a second test to confirm the results. Two normal tests usually means that the man doesn't have any significant infertility problems. If something in the results looks irregular, your doctor might order further tests to pinpoint the problem. At this point, if you aren't already seeing a urologist, you should considering seeing a specialist.

There are a number of potential problems that a semen analysis can detect. They include:

  • Azoospermia. No sperm are produced, or the sperm aren't appearing in the semen.
  • Oligiospermia. Few sperm are produced. 
  • Problems with sperm motility. If sperm aren't moving normally, they are less likely to be capable of fertilizing an egg. 
  • Problems with sperm morphology. Problems with the form and structure -- or morphology -- of the sperm may cause infertility. 

But while these conditions may be the direct reason that you can't conceive, they themselves may be caused by an underlying medical condition. Your doctor will probably want to investigate the issue further by ordering blood and urine tests or other procedures.

Reasons for Male Infertility

There are a wide number of reasons for male infertility. Some are caused by physical problems that prevent the sperm from being ejaculated normally in semen. Others affect the quality and production of the sperm itself.

Possible problems include:

  • Sexually transmitted diseases or other infections. Genital infections such as chlamydia and gonorrhea can cause infertility in men. The infertility can often be resolved by treating the infection.
  • Blockages, birth defects, or physical damage.
  • In some cases, men are born with blockages in parts of the testicle or other abnormalities that prevent sperm from getting into the semen. Physical trauma to the testicles, prostate, and urethra (define) can also result in fertility problems. Surgery can sometimes correct the problem.
  • Retrograde ejaculation.

In this condition, semen doesn't come out of the penis during ejaculation but instead enters the bladder. It can be caused by diabetes, certain medications, and surgery to the bladder, prostate, or urethra.

Genetic diseases.

  • Although it's rare, genetic illnesses such as cystic fibrosis or chromosomal disorders can cause infertility.
  • Autoimmune problems.
  • In some cases, the immune system can mistakenly target sperm cells and treat them as if they were a foreign virus. The sperm can become damaged as a result.

Hormonal problems.

  • Certain hormonal imbalances -- in the pituitary and thyroid glands, for instance -- can cause infertility. Your doctor may suggest treatment with medication.

Sexual problems.

Erectile dysfunction (impotence) and premature ejaculation can obviously have an effect on fertility. Erectile dysfunction can be caused by psychological problems such as anxiety, guilt, or low self-esteem. It is also caused by physical problems such as diabetes, high blood pressure, high cholesterol, and heart disease. In addition, impotence may be a side effect of certain medications such as antidepressants. Talk to your doctor about ways of treating any sexual problems.

Varicoceles.

Varicoceles are enlarged varicose veins that develop in the scrotum and prevent blood from flowing properly. Varicoceles are found in 15% of all men, but in up to 40% of men being evaluated for infertility. Although they may be a factor in male infertility, recent studies question whether surgery to correct varicoceles has any beneficial effect.

Other Factors That May Cause Male Infertility:

  • Excessive exercise. Studies have shown that exercising too much may lead to the release of too many steroid hormones. This can affect fertility.
  • Stress. 
  • Obesity. 
  • Use of drugs, alcohol, or tobacco. Smoking tobacco, using drugs such as marijuana and cocaine, and taking steroids can reduce sperm counts. 
  • Exposure to toxins and environmental hazards. Pesticides, lead, radiation, radioactive substances, mercury, and heavy metals may affect fertility. 
  • Heat. Although the effect is usually temporary, high temperatures in the testicles could reduce sperm production. High heat could result from wearing clothing that's too tight and traps heat, frequent bike riding, or by taking too many hot baths or saunas.

Getting Pregnant When Male Factor Infertility Is Involved

  • If you're a guy who has been diagnosed with infertility, you should talk to your doctor about any behavorial changes you can make that might increase your chances of conceiving.
  • If your sperm count is low, your doctor may recommend having intercourse less frequently in order to build up a better concentration of sperm. You should also ask about taking vitamins. Some recent studies have found that men can improve their low sperm counts by taking a combination of a folic acid and zinc.
  • If you have abnormal hormone levels, your doctor may recommend hormone treatment.
  • If you have retrograde ejaculation, you can often treat this with common over-the-counter cold medicine.
  • In some cases where the man has mild infertility, artificial insemination or other assisted reproduction techniques, such as GIFT and ZIFT, may be helpful. One exciting treatment for male infertility and low sperm count is a form of micromanipulation called intracytoplasmic sperm injection (ICSI). This is a laboratory procedure in which sperm and eggs are retrieved from both partners, and then a single sperm is injected into an egg. The fertilized egg is then implanted into the woman's uterus.
  • If the man doesn't have sperm in his semen, one of several techniques can be used to retrieve sperm from the testicles. Success rates are generally good -- as high as 65% in some clinics. But factors such as poor sperm quality, poor egg quality, and older age of the mother can lessen the chance of success. Other techniques that might help men with fertility problems are being developed.